Expandable spinal implant apparatus and method of use

ABSTRACT

A spinal implant apparatus that is an expandable spacer including features to minimize or eliminate spacer cant or offset during and after completing the expansion process. The spacer includes a top component, a base component in engagement with the top component, and an expansion mechanism arranged to change the top component&#39;s position with respect to the base component. The mechanism for causing expansion may be a screw, a cam, a wedge or other form of distracting device. In one embodiment, the expandable spacer includes a base component with a set of towers and a top component with a set of corresponding silos, where the towers and silos are configured to minimize or eliminate tilt of the top component as it extends upwardly from the base component. In another embodiment, the spacer may include a stepped arrangement around the perimeter of the top component and the base component for engagement during height expansion with minimal canting or slippage. In another embodiment, the spacer may include texturing modification at the opposite ends of the longitudinal axis of the spacer to prevent tilting, slipping, or canting. Additionally, a portion of one or more exterior surfaces of the spacer may be textured, sawtoothed, dovetailed or the like to increase frictional intervertebral contact. The spacer may contain one or more passageways of selectable shape/dimension for bone growth through the spacer.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. patent applicationSer. No. 12/774,429, filed May 5, 2010, which relates to, and claimspriority in, U.S. Provisional Patent Application Ser. No. 61/175,918,entitled “EXPANDABLE SPINAL IMPLANT APPARATUS” filed May 6, 2009 by thesame inventor. The contents of both applications are incorporated hereinby reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an expandable spinal implant apparatusand a method of using the apparatus to treat a spine disorder. Moreparticularly, the present invention relates to an intervertebral spacerarranged for expansion of one or more dimensions of the spacer withoutcanting, tilting, or slipping, and methods of using the expandablespacer.

2. Description of the Prior Art

Back pain can be caused by anyone of several problems that affect thevertebral discs of the spine. These problems include, for example,degeneration, bulging, herniation, thinning of a disc, or abnormalmovement, and the pain that is experienced generally is attributable tofriction or pressure that inevitably occurs when one adjacent vertebraexerts uneven pressure, or when both adjacent vertebrae exert suchpressure, on the disc. Back pain may also be attributed to neuralelement injury.

Whenever an individual suffers from a disc problem, a typical remedy isto perform interbody, intervertebral, cervical, thoracic or lumbarfusion (all generically referred to herein as IF) surgery on the patientfor the purpose of fusing the two vertebrae that flank the defectivedisc to form a single, solid bone mass. Existing IF techniques generallyinvolve removing the offending disc from the patient, adding bone graftmaterial into the interbody space between the flanking vertebrae, andalso inserting a spinal implant device into that space to hold the graftmaterial in place and to support the flanking vertebrae while solid bonemass forms.

Existing IF techniques fail to enable fine positioning or stableexpansion of an implant device with respect to the vertebrae. A briefdiscussion of the basic anatomy of the human spine, and specifically,the lumbar vertebrae of the spine, will help better illustrate thislimitation. FIG. 1 shows a representation of a human vertebral disc 310,as it is arranged between a superior vertebra 320 and an inferiorvertebra 330, in a partial representation of the lumbar region of ahuman spine. Specifically, the disc 310 is positioned between bottomsurface 321 of the superior vertebra 320 and top surface 331 of theinferior vertebra 330. FIG. 2 shows a representation of the top surface331 of the inferior vertebra 330. The inferior vertebra 330 includes avertebral body 332 formed by a cortical rim 333, which is a dense, hardshell that is formed by compact bone, and an end plate portion 334,which is formed by much softer and less compact end plate material.

Referring to FIG. 3, existing IF procedures, including those associatedwith the lumbar region, involve positioning one or two spinal implantdevices (an exemplary existing spinal implant device is shown as element350 in FIG. 3) substantially centered on the end plate portion 334 ofthe inferior vertebra 330 and the bottom surface 321 of the end plateportion of the superior vertebra 320. Positioning the device in this waydoes not promote lordosis. Further, in this position, the device 350tends to depress upon, or even become embedded in, the end plate portion334 of the inferior vertebra 330 and/or the opposing end plate portion324 of the superior vertebra 320. This settling of the implant device isreferred to as subsidence. When this subsidence occurs, thevertebrae-supporting properties of the device 350 are reduced oreliminated. The result may be loss of intervertebral space height and/orless than desirable coronal and/or sagittal alignment of the spine.

Existing IF procedures are further limited in other ways. During IFsurgery, the surgeon must navigate the spinal implant device through aregion that is densely packed with neural elements, muscle, ligaments,tendons and bone to access the top surface 331 of the inferior vertebra330. In existing IF techniques, this requires extensive cutting and/ormanipulation of this region, which can extend patient recovery time andsubject the patient to other side effects, such as, for example,inflammation, which can be discomforting. Worse, in some patients, thepatient must be entered in two or three of three possible body areas(i.e., the patient's posterior region in a posterior interbody fusiontechnique, the patient's anterior region in an anterior interbody fusiontechnique, laterally in a lateral interbody fusion technique and/or thepatient's transforaminal region in a transforaminal interbody fusiontechnique) for the purpose of positioning the spinal implant device. Itis also to be noted that existing IF techniques are substantiallyinvasive and can be difficult to perform.

One aspect of the limitation of the existing tools used in the IFprocess relates to the design of the spacer. In some IF procedures,locating the spacer in the position of interest cannot be done by handalone. Instead, a tool is required to push the spacer to the position ofinterest, particularly when promoting lordosis is the goal. Presentspacers are configured so that the interface with the positioning tooloccurs only on the primary longitudinal axis, one of the orthogonalaxes, of the spacer. For example, the spacers are rectangular andinclude a port that is centrally aligned with the primary longitudinalaxis of the spacer used to releasably receive the positioning tooltherein.

Some spacers include a mechanism for changing the dimensions of thespacer, such as the height dimension. The mechanism permits dimensionchange after the spacer has been placed at or near the location ofinterest. The ability to change the height dimension of the spacerimproves the chance of achieving desired intervertebral space height aswell as coronal and sagittal balance. The present mechanisms may notproduce uniform expansion of the spacer. As a result, the spacer may getcaught on itself along one side, in a comer, etc., and will end up witha non-uniform height. The spacer is less effective than desired in sucha canted state. It can cause pain for the patient and extend therecovery period, possibly with less than complete fusion established.

Another problem with existing expansion mechanisms relates to spacerrocking. That is, for a two-piece spacer in which one part extends froma base piece, the tolerances between the two pieces may be significantenough that the extension piece will rock or pivot on the base piecewhen in an extended position. This, too, produces a spacer ofnon-uniform height. The spacer is less effective in producing thedesired intervertebral space height and/or coronal/sagittal alignment.

What is needed therefore is an expandable spinal implant apparatusconfigured to ensure uniform expansion with minimal or no rocking,canting, tilting, or slipping during and after the expansion process.Such an apparatus would decrease patient risk, speed recovery andsubstantially improve success rates in terms of restoration of normalspinal confirmation (i.e., intervertebral space height as well ascoronal and sagittal alignment) and neurological decompression.

BRIEF SUMMARY OF THE INVENTION

It is an object of the present invention to provide an apparatus fortreating a patient in need of IF surgery. The present apparatus is anexpandable spacer including a top component, a base component inengagement with the top component, and an expansion mechanism arrangedto change the top component's position with respect to the basecomponent or vice versa, which results in a change in the size,dimension, and/or shape of the spacer. The top and base componentsremain in engagement with each other throughout and after the positionchanging process.

When in position, the top component of the spacer is in contact with thebottom surface of the end plate portion of the superior vertebra, andthe base component is in contact with the top surface of the inferiorvertebra. The expandable spacer is arranged such that the topcomponent's position may be changed with respect to the base component,or vice versa. The base component and the top component includeconfigurations to keep the two components in substantial contact andalignment with one another throughout the dimension changing process.The two components remain in engagement with one another, either alongsome or all of their respective perimeters and/or within their interiorregions, during the dimension change. This arrangement eliminates thepossibility of spacer cant during expansion and when in an expandedstate.

The spacer of the present invention includes a configuration thatpermits the surgeon to expand at least one of its dimensions subsequentto placement at the selected position of interest. While referred toherein as a mechanism to expand a dimension or change the position ofthe components, it is to be understood that the mechanism causes achange of size, dimension and/or shape of the spacer. The expansionmechanism can be a screw, wedge, cam or any other type of distractingdevice capable of causing movement of one component of the spacer withrespect to another component of the spacer. This is referred to as theposition changing process.

Three embodiments of the expandable spacer with configurations designedto increase the engagement of their contacting surfaces in order tominimize or eliminate slipping, tilting, and/or canting during and afterthe position changing process are disclosed herein. The interfacesand/or surfaces of either or both of the top component and the basecomponent (both external and internal) may be smooth, textured, ribbed,sawtoothed or otherwise modified to optimize the frictional engagementbetween the components. The expandable spacer of the present inventionmay include interior spaces therethrough which promote bone packingand/or bone growth.

In addition, at least a portion of one or more of the exterior surfacesof the top and/or base component may be modified to optimize frictionalengagement with the vertebrae between which the spacer is positioned.The spacer may be configured so that it has a higher frictionalengagement at the one end. For example, the front end may have a higherfrictional engagement and engage tightly with the vertebral end platewhereas the back end of the spacer may have a lower frictionalengagement with the vertebral end plate. This configuration enables adesirable type of sliding or positioning of the spacer during insertion.

The expandable spacer may also include one or more off-axis positioninginterface sites and/or one or more on-axis positioning interface sites.For purposes of description of the present invention, “off-axis” means asteerage, directional and/or expansion contact location that is anywherepart of the spacer except at a location that is aligned with the primarylongitudinal axis of the spacer. An off-axis location may include anynon-orthogonal locations as well as orthogonal locations except for theprimary longitudinal axis (on axis). The contact sites are arranged forreleasable interfacing with a steering and/or expansion tool and enablefine and minimally invasive manipulation within the patient forpositioning the spacer at the desirable location.

The spacer includes, for the ease of description, a generallyrectangular body shape with one or more curved surfaces, but is notlimited thereto. In one or more embodiments it may include one or morechamfered corners of the rectangular shape suitable for including atsuch corners an off-axis positioning interface, such as a port arrangedto allow releasable insertion of a tool insert. For an expandable spacerof the present invention including such off-axis interface port, one ormore of the one or more chamfered corners may include a nodule or pinthat may be releasably joined to a tool interface. The off-axis versionof the spacer is thus configured to enable its steerage from a startinglocation to the desirable location at more than just straight-linemovements using a positioning tool of interest. Such a spacer may bemoved at 30°, 45°, or any other angles of interest including orthogonalangles other than on the primary longitudinal axis of the spacer.

The present invention also encompasses a method of inserting,positioning, and expanding the expandable spacer in the intervertebraldisc space between two adjacent vertebrae, including the steps ofproviding an expandable spacer including a top component, a basecomponent in engagement with the top component, and an expansionmechanism arranged to change the top component's position with respectto the base component. The spacer may include one or more off-axispositioning interface sites and/or one or more on-axis positioningsites, the on-axis interface being coincident with or parallel to thelongitudinal axis of the spacer, and the off-axis interface being angledwith respect to the longitudinal axis. The method further includes thesteps of inserting the spacer at least partially into the intervertebraldisc space.

The method may further include the steps of engaging a tool to anyoff-axis or on-axis interface sites of the spacer, and inserting thespacer further into the intervertebral disc space by moving the toolsubstantially along the insertion direction. The combination of theinserting steps may result in the longitudinal axis of the spacer beingperpendicular to the insertion direction. The longitudinal axis of thespacer may be substantially parallel to a medial-lateral axis of theintervertebral disc space. The inserting steps may result in the spacerbeing positioned in an anterior aspect of the intervertebral disc space.The inserting steps may include allowing the spacer to rotate withrespect to the insertion direction. The spacer may further include afront end having frictional properties that are greater than frictionalproperties of a rear end of the spacer, and the inserting steps mayinclude allowing the front end to turn within the intervertebral discspace as it frictionally engages one or both of the adjacent vertebrae.The on-axis and off-axis interfaces may be ports, the tool may include aretractable member, and the engaging steps may include placing theretractable member in the respective ports. The combination of theinserting steps may result in the longitudinal axis of the spacer beingrotated approximately 90 degrees with respect to the insertiondirection. The method further includes the step of expanding the spacer.The method may further include the step of packing bone graftingmaterial in one or more openings of the spacer before and/or afterexpansion has occurred.

The present invention is applicable in any type of spinal surgery. Whilethe focus of the discussion of a preferred embodiment of the inventionis directed to lumbar IF surgery, it is to be understood that theinvention may be employed in cervical and thoracic spinal procedures aswell from any direction, i.e., anterior, posterior and lateral.

The present invention is constructed to decrease patient risk, speedrecovery and substantially improve success rates in terms of restorationof normal spinal confirmation and neurological decompression. This isachieved by providing the surgeon with an expandable spacer that is bestsuited for the patient's condition and alterable in size, dimensionand/or shape to further improve the implant's clinical result. These andother advantages of the present invention will become apparent uponreview of the following description and accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view representation of a partial spinal arrangement ofa vertebral disc and two vertebra, a superior vertebra and an inferiorvertebra, that are immediately adjacent to the vertebral disc.

FIG. 2 is a top view of the inferior vertebra of FIG. 1 after the discof FIG. 1 has been surgically removed from the inferior vertebra.

FIG. 3 shows an exemplary prior spinal implant device positioned betweenthe end plate portions of the inferior and superior vertebrae of FIG. 1.

FIG. 4 is a perspective view of a first embodiment of the expandablespacer of the present invention prior to expansion.

FIG. 5 is a perspective view of the expandable spacer of FIG. 4 in anexpanded state.

FIG. 6 is a side view of the expandable spacer prior to expansion,corresponding to FIG. 4.

FIG. 7 is a side view of the expandable spacer expanded, correspondingto FIG. 5.

FIG. 8 is a top view of the expandable spacer prior to expansion,corresponding to FIG. 4.

FIG. 9 is a top view of the expandable spacer expanded, corresponding toFIG. 5.

FIG. 10 is a top view of the first embodiment of the expandable spacerwith the base component and the top component separated from oneanother.

FIG. 11 is a cross sectional side view of the first embodiment of theexpandable spacer with the base component and the top componentseparated from one another.

FIG. 12 is a perspective view of a second embodiment of the expandablespacer of the present invention prior to expansion.

FIG. 13 is a perspective view of the expandable spacer of FIG. 12 in anexpanded state.

FIG. 14 is a top view of the second embodiment of the expandable spacerwith the base component and the top component separated from oneanother.

FIG. 15 is a cross sectional side view of the expandable spacer of FIG.12, showing internal surface modifications to promote surface areacontact between the base and top components.

FIG. 16 is a perspective view of an alternative form of the firstembodiment of the expandable spacer of the present invention prior toexpansion illustrating two off-axis steering interface sites.

FIG. 17 is a perspective view of the expandable spacer of FIG. 16 in anexpanded state.

FIG. 18 is a top view of the third embodiment of the expandable spacerof the present invention prior to expansion illustrating two bonepacking interior spaces.

FIG. 19 is a bottom perspective view of the top component of expandablespacer of FIG. 18 illustrating teeth on two portions of the exteriorperimeter wall.

FIG. 20 is a side view of the third embodiment of the expandable spacerof the present invention prior to expansion.

FIG. 21 is a perspective view of the expandable spacer of FIG. 20 priorto expansion.

FIG. 22 is side view of the third embodiment of the expandable spacer ofthe present invention in an expanded state, illustrating theinterlocking teeth engaging two portions of the top and base components.

FIG. 23 is a perspective view of the expandable spacer of FIG. 22 in anexpanded state.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION

A first embodiment of an expandable spacer 10 of the present inventionis shown in FIGS. 4-11. The spacer 10 is shown in FIGS. 4, 6 and 8 priorto expansion, and in FIGS. 5, 7 and 9 in an expanded state. It is to benoted that while the spacer 10 is shown in FIGS. 4-11 in a substantiallyrectangular shape with a generally curved forward portion, theexpandable apparatus of the present invention may come in a range ofshapes and sizes. The surgeon may choose a particular spacer size andshape suitable for a given application. The spacer 10 of the presentinvention is directed to the structural configuration thereof thatenables the surgeon to expand the height dimension without any resultingrocking, tilting, slipping, or canting of the spacer 10. The spacer 10may include one or more on-axis and/or one or more off-axis positioninginterface sites. Spacer size, shape and positioning interface siteoptions and examples are described in the present applicant's previouslyfiled provisional application No. 61/040,821 filed Mar. 31, 2008, andprovisional application No. 61/091,505 filed Aug. 25, 2008. The contentsof those applications are incorporated herein by reference.

The spacer 10 includes a base component 12, a top component 14 and aheight adjuster 16. The base component 12 includes a receiver 18 withdimensions and shape suitable to receive and removably retain the topcomponent 14 there. That is, at least a portion of the externaldimensions of the top component 14 are less than the internal dimensionsof the receiver 18 of the base component 12. In this embodiment theexternal dimensions of the top component 14 are arranged to fit entirelywithin the receiver 18. In this embodiment, the receiver 18 of the basecomponent 12 further includes a height adjuster port 20, a heightadjuster slot 22 and a plurality of cant minimizing towers such as, forexample, first tower 24 and second tower 26. Each tower includes aperimeter wall 28 and may include an interior space 30. The effects of aplurality of silos and towers can be achieved with other configurationsof the top and base components of the spacer and are included within thescope of the invention.

In this embodiment, the top component 14 includes a height adjuster port32, a height adjuster slot 34 and a plurality of cant minimizing silossuch as, for example, first silo 36 and second silo 38. Each siloincludes a perimeter wall 40 and may include an interior space 42. Eachof silos 36 and 38 has dimensions and shape to receive and removablyretain therein the towers 24 and 26 of the receiver 18 of the basecomponent 12. That is, the external dimensions of the towers 24 and 26are less than the internal dimensions of the silos 36 and 38. The basecomponent 12 and the top component as shown in FIGS. 4-11 are arrangedso that the top component 14 fits within the receiver 18 of the basecomponent 12, the first tower 24 fits within the first silo 36 and thesecond tower 26 fits within the second silo 38 when the top component 14is inserted into the base component 12. In general, outer perimeter 15of the top component 14 fits within inner perimeter slot 19 of thereceiver 18 adjacent to the towers 24 and 26. The base component 12 andthe top component 14 are configured so that top surface 44 of the topcomponent 14 is flush with top surface 46 of the base component 12 priorto expansion of the spacer 10, as shown in FIGS. 4 and 6.

The combination of the height adjuster 16, the height adjuster slot 22of the base component 22 and the height adjuster slot 34 of the topcomponent 14, enables the surgeon to raise the top component 14 withrespect to the base component 12, as shown in FIGS. 5 and 7. The heightadjuster is sized and shaped with external dimensions that are greaterthan the internal dimensions of the height adjuster slot 22 of the basecomponent 12 and the height adjuster slot 34 of the top component 14.The height adjuster slots 22 and 34 are inwardly tapered from theirrespective ports 20 and 32 toward opposing sides 48 and 50. They arealso arranged with compatible configurations to form a unitaryadjustment channel (not shown) within which the height adjuster 16 maybe progressed. As a result, when the top component 14 is positioned inthe receiver 18, the height adjuster 16 may be progressed starting fromthe combination of ports 20 and 32 into the combination of slots 22 and34 toward opposing sides 48 and 50. As it makes that progression, theheight adjuster 16 forces the top component 14 out of the receiver 18 ofthe base component 12. This arrangement enables the surgeon to increaseselectively the height of the spacer 10.

The height adjuster 16 may be any means suitable for use in an IFprocedure. It must be accessible by the surgeon when the spacer 10 ispositioned between vertebrae. When the spacer 10 has been positioned inthe location of interest, the height adjuster 16 may be moved into thecombination of slots 22 and 34 in a manner that causes the top component14 to extend upwardly from the base component 12. As shown in FIGS. 10and 11, the slots 22 and 34 are threaded and tapered. The heightadjuster 16 suitable for use with such slot configurations is alsothreaded but it is not tapered. Instead, it is of fixed diameter so thatas it is threaded into the slots 22 and 34, it forces the top component12 out of the receiver 18. Those of skill in the art will recognize thatthe height adjuster 16 and the slots 22 and 34 may be of differentconfigurations, provided they are designed to cause the upward movementof the top component 14 with respect to the base component 12 when theheight adjuster 16 is moved into the slots 22 and 34.

The height adjuster 16 is an expansion mechanism configured to enablethe movement of one component of the spacer 10 with respect to anotherto cause the expansion/change in shape of the spacer 10. Other expansionmechanisms may be employed for that purpose without deviating from thescope of the invention. For example, in addition to a screw-typemechanism such as the height adjuster 16 shown in the figures, theexpansion mechanism may be a cam, a wedge, or other type of distractingdevice capable of advancement into the combination of slots 22 and 34 orsome other form of port arrangement and capable of displacing the topcomponent 14 with respect to the base component 12, or the basecomponent 12 with respect to the top component 14.

An advantage of the expandable spacer 10 of the present invention is theminimizing of any canting, slipping or tilting during and afterexpansion. This is achieved by the top and base components remaining inengagement with each other during expansion of the spacer. In this firstembodiment this is achieved by the combination of the towers 24 and 26of the base component 12 and the silos 36 and 38 of the top component14. In another embodiment, this is achieved by texturing at least aportion of the top and base components that are in contact with eachother.

Expandable spacers have been provided in the past; however, as noted,they can be unsuitable for use when the expanded portion extends at anangle so that there is limited contact between the spacer and thevertebra above it. This can cause the patient pain and slow bone growththrough the spacer, which can cause delayed recovery for the patient.The spacer 10 eliminates that limitation. When the height adjuster 16 isprogressed into the slots 22 and 34, the top component 14 risesuniformly because the top component 14 remains in substantial contactwith the base component 12 at the towers/silos interface, or at thetextured area of the at least a portion of the top and base componentsthat are in contact with each other. The towers 24/26 and the silos36/38 or the top and base components, of which at least a portion may betextured, are arranged for close sliding engagement with one another.The tolerance between those structures should be sufficiently close sothat there is very little gap between them and, therefore, little or noopportunity for canting, tilting, or unintended slipping to occur.

The spacer 10 further optionally includes means to enable bone growththerethrough to facilitate the fusion process. In one embodiment, eachof the towers 24 and 26 of the base component 12 preferably includesinterior space 30. Additionally, each of the silos 36 and 38 includesinterior space 42. When the base component 12 and the top component 14are engaged with one another, the interior spaces 30 and 42 are alignedso that there exists a complete passageway from the top surface 44/46 ofthe spacer 10 to the bottom surface 60. Bone fusion material may bepacked into those passageways. That is, more generally, the spacer 10 isconfigured to include one or more through and through passageways, whichpassageways allow bone packing in the post-expanded spacer. It is to benoted that the passageways may not be completely through and through. Itis also to be noted that the passageways may be filled with the bonegrafting material after the spacer 10 has been expanded. In thatsituation, the passageways may not be completely through and throughand/or they may be offset with respect to the top component 14 and thebase component 12.

The expandable spacer 10 of the present invention may include on-axisand/or off-axis insertion arrangements such as interface ports 62 and 64as shown in FIGS. 16 and 17. Further, the spacer 10 may be rectangular,curved or other configurations of interest. The spacer may be placed inposition using a placement device or tool as described in the other twoprovisional applications referenced herein, for example.

One or more surfaces of the base component 12 and/or the top component14 may be textured, sawtoothed, dovetailed and/or otherwise modified tooptimize frictional engagement with the vertebrae between which thespacer 10 is positioned to reduce any undesired slipping. The spacer maybe configured so that it has a higher frictional engagement at the oneend than the other end to enable a desirable type of sliding orpositioning of the spacer during insertion.

In addition or alternatively, the portions of the base and topcomponents that are in contact with one another may be textured,sawtoothed, dovetailed, stepped and/or otherwise modified to optimizesurface area contact between those components. Doing so reduces anyslippage or canting problems associated with the height dimension of thespacer that may occur when the spacer is an expanded state, includingwhen expanded in the desired intervertebral position.

A second embodiment of an expandable spacer 100 depicting thisconfiguration is shown in FIGS. 12-15, wherein elements corresponding tolike elements of the expandable spacer 10 have the same identifyingnumbers. The expandable spacer 100 includes a base component 102, a topcomponent 104 and a height adjuster 106. The base component 102 includesa receiver 108 with dimensions and shape suitable to receive andremovably retain the top component 104 there. That is, the externaldimensions of the top component 104 are less than the internaldimensions of the receiver 108 of the base component 102. The receiver108 of the base component 102 further includes a height adjuster port110, a height adjuster slot 112 and an interior perimeter wall 114. Thebase component 102 also includes one or more base packing ports 116extending entirely therethrough at least in the receiver 108 area butnot limited thereto. The base component 102 and the top component 104are configured so that top surface 105 of the top component 104 is flushwith top surface 103 of the base component 102 prior to expansion of thespacer 100. The expandable spacer 100 may be expanded in the mannerdescribed with respect to the spacer 10.

The top component 104 includes a height adjuster port 118, a heightadjuster slot 120 and an exterior perimeter wall 122. The top component104 also includes one or more top packing ports 124 extending entirelytherethrough and configured to align with the one or more base packingports 116 so that when the base component 102 and the top component 104are engaged with one another, there is at least one port extendingentirely through the spacer 100 to permit bone packing therein. It is tobe understood that the bone packing ports can be arranged in otherconfigurations and remain within the scope of the invention. Thedimensions of the top component 104 are selected to ensure that the topcomponent fits snugly within the receiver 108 of the base component 102.It is to be noted that the bone packing ports may be employed to packbone grafting material after the spacer 100 has been expanded. In thatsituation, passageways from one side of the spacer 100 to the other maynot be completely direct but may have one or more offset aspects.

The interior perimeter wall 114 of the base component 102 and theexterior perimeter wall 122 of the top component 104 are configured toincrease the surface contact area between those two components and aretextured, sawtoothed, dovetailed and/or otherwise modified to optimizefrictional engagement with these components to reduce any undesiredtilting, canting, or slipping during and after expansion of the spacer100. The modification may be located on the entirety of the componentsurfaces in engagement with each other or a portion thereof. Forexample, the modification may be located at the opposite ends of thelongitudinal axis of the spacer. In the embodiment depicted, theentirety of the interior perimeter wall 114 and the exterior perimeterwall 122 are not smooth. In this embodiment of the expandable spacer100, the interior perimeter wall 114 of the base component 102 includesa plurality of tiers of interior steps 126 and the exterior perimeterwall 122 of the top component 104 includes a plurality of tiers ofexterior steps 128. The interior steps 126 and the exterior steps 128are configured in mirror opposing orientations so that when the spacer100 is expanded, the steps 126/128 interlock with one another, therebyincreasing the engagement of the top component 104 with the basecomponent 102 so that the two remain in secure contact with one another,minimizing any height slippage or canting of the spacer 100 when in anexpanded state. As shown in FIG. 15, and beginning from top surface 103of the base component 102, the steps 126 of the base component 102extend outward horizontally from the interior perimeter wall 114 andangle downward and inward back to the interior perimeter wall 114.Further, beginning from top surface 105 of the top component 104, thesteps 128 extend outward and downward at an angle from the exteriorperimeter wall 122 before extending rearward horizontally back to theexterior perimeter wall 122. The angles of the steps 126 and 128 shouldbe substantially equal and opposite. Those of skill in the art willrecognize that other interlocking configurations of the steps 126 and128 may be established.

The steps 126/128 may be of sawtooth configuration as shown, or they maybe rectangular, triangular or other suitable configuration. The steps126/128 may be located on all component surfaces or portions thereof. Inalternative embodiments of the expandable spacer 100, the interiorperimeter walls 114 of the base component 102 and the exterior perimeterwalls 122 of the top component 104 may be textured, dovetailed orotherwise surface modified to enhance the frictional engagementtherebetween. The step arrangement provides a ratcheting or ladder-likemechanism to enable expansion while eliminating or minimizing togglingor settling of the spacer 100.

The steps 126 and 128 of the expandable spacer 100 may be elasticallydeformable in one direction so that when the spacer 100 is expanded, thesteps 126 of the base component 102 may give as the steps 128 of the topcomponent 104 are pushed pass them with the insertion of the heightadjuster 16 into slots 20 and 32. Once a set of steps 128 of aparticular tier engages a set of steps 126 of a tier above, there isresistance to a return of that set of steps 128 to a lower tier of theset of base component steps 126. Further, the spacing between tiers ofsteps 126/128 may be established in specific increments so that thesurgeon is able to adjust the height increase of the spacer 100 veryspecifically by counting the number of tiers of step engagement thatoccurs. For example, each tier may be spaced from adjacent tiers by onemillimeter. Making three incremental changes in stepped tier engagementswould correspond to a three millimeter spacer expansion.

Relatedly, the height adjuster 106 may be arranged with coding such thatits rotation by some selected value corresponds to a tier change. I.e.,a quarter-turn culminating with a click can be used to signify that atier change has been made. Those of skill in the art will recognize thatother arrangements for linking height adjuster changes with expansionvalues may be established without deviating from this concept.

The embodiment of the expandable spacer 100 shown in FIGS. 12-15 has nocant-minimizing silos and towers arrangement such as included in thespacer 10 of FIGS. 4-11. Nevertheless, the spacer 100 may optionallyinclude such silo-and-tower arrangement. If the silos and towers areincluded, they may or may not also include steps corresponding to thesteps 126/128 of the perimeter walls of the base component 102 and thetop component 104.

Although not depicted in this embodiment, the spacer 100 can be madewith steering ports or interface sites to enable a surgeon to positionthe spacer in a desired position. The expandable spacer 100 of thepresent invention may include on-axis and/or off-axis insertionarrangements or ports as shown in FIGS. 16 and 17 in relation to spacer10. Further, the spacer 100 may be rectangular, curved or otherconfigurations of interest. The spacer may be placed in position using aplacement device or tool as described in the other two provisionalapplications listed herein.

A third embodiment of an expandable spacer 200 is shown in FIGS. 18-23,wherein elements corresponding to like elements of the expandable spacer10 have the same identifying numbers. The expandable spacer 200 includesa base component 202, a top component 204 and a height adjuster 206. Thebase component 202 includes a receiver 208 with dimensions and shapesuitable to receive and removably retain a portion of the top component204 there. That is, a portion of the external dimensions of the topcomponent 204 are less than the internal dimensions of the receiver 208of the base component 202. The top component 204 has a cap 210 that doesnot fit within the internal dimensions of the receiver 208 (see FIG.19), and extends over the base component 202. The cap 210 of the topcomponent 204 ends in two beveled surfaces on the opposite end of thespacer 200 from the height adjuster 206. In this embodiment the cap 210sits on top of the base component 202 over the entire perimeter thereof.However, it is to be understood that other configurations orarrangements of a top component 204 with a cap 210 or partial cap (notshown) are within the scope of the invention. The base component 202includes bone packing ports 212 on the side wall of the base component202, and also includes one or more bone packing ports 216 extendingentirely therethrough at least in the receiver 208 area. Other bonepacking port arrangements or configurations are encompassed in theinvention. It is to be noted that the bone packing ports may be employedto pack bone grafting material after the spacer 200 has been expanded.In that situation, passageways from one side of the spacer 200 to theother may not be completely direct but may have one or more offsetaspects.

As shown in FIGS. 20 and 21, the base component 202 and the topcomponent 204 are configured so that the bottom of the top surface 205of the top component 204 sits directly on the top surface 203 of thebase component 202 prior to expansion of the spacer 200. The expandablespacer 200 may be expanded in the manner described with respect to thespacer 10. In this embodiment, the height adjuster 206 is a screw-typemechanism situated at one end of the spacer at an angle to thelongitudinal axis of the spacer that pushes against a lifting wedge 232,which causes the top component 204 to rise from the base component 202.As a result, when the top component 204 is positioned in the receiver208, the height adjuster 206 may be progressed from where it extendsbeyond the perimeter wall of the top component 204 and base component202, pushing the lifting wedge 232 towards the same end of the spacer asthe beveled end of the cap 210.

The top component 204 includes bone packing ports 214 on the side wallof the top component 204, and also includes one or more top packingports 224 extending entirely therethrough and configured to align withthe one or more base packing ports 216 so that when the base component202 and the top component 204 are engaged with one another, there is atleast one port extending entirely through the spacer 200 to permit bonepacking therein. It is to be understood that the bone packing ports canbe arranged in other configurations and remain within the scope of theinvention. The dimensions of the top component 204 are selected toensure that the top component fits snugly within the receiver 208 of thebase component 202.

An interior perimeter wall 230 of the base component 202 and an exteriorperimeter wall 222 of the top component 204 are configured to increasethe surface contact area between those two components and are textured,sawtoothed, dovetailed and/or otherwise modified to optimize frictionalengagement with these components to reduce any undesired tilting,canting, or slipping during and after expansion of the spacer 200. Themodification may be located on the entirety of the component surfaces inengagement with each other or a portion thereof. For example, themodification may be located at the opposite ends of the longitudinalaxis of the spacer 200. In the embodiment depicted, the modification islocated at two discrete locations at opposite ends of the longitudinalaxis of the spacer 200. That is, a portion the interior perimeter wall230 and the exterior perimeter wall 222 are textured. In this embodimentof the expandable spacer 200, the interior perimeter wall 230 of thebase component 202 includes directional locking teeth 226 and theexterior perimeter wall 222 of the top component 204 includescomplimentary teeth 228 (see FIG. 22). The interior teeth 226 and theexterior teeth 228 are configured in mirror opposing orientations sothat when the spacer 200 is expanded, the teeth 226/228 interlock withone another, thereby increasing the engagement of the top component 204with the base component 202 so that the two remain in secure contactwith one another, minimizing any height slippage or canting of thespacer 200 during expansion or when in an expanded state. It is to benoted that a portion or all of the interior perimeter wall 230 and aportion or all of the exterior perimeter wall 222 may be textured.

As shown in FIG. 23, and beginning from top surface 203 of the basecomponent 202, the teeth 226 of the base component 202 extend outwardhorizontally from the interior perimeter wall 230 and angle downward andinward back to the interior perimeter wall 214. Further, beginning fromtop surface 205 of the top component 204, the teeth 228 extend outwardand downward at an angle from the exterior perimeter wall 222 beforeextending rearward horizontally back to the exterior perimeter wall 222.The angles of the teeth 226 and 228 should be substantially equal andopposite. Those of skill in the art will recognize that otherinterlocking configurations of the teeth 226 and 228 may be establishedand are within the scope of the invention.

The teeth 226/228 may be of sawtooth configuration as shown, or they maybe rectangular, triangular or other suitable configuration. The teeth226/228 may be located on all component surfaces or portions thereof. Inalternative embodiments of the expandable spacer 200 the interiorperimeter wall 230 of the base component 202 and the exterior perimeterwall 222 of the top component 204 may be textured, dovetailed orotherwise surface modified to enhance the frictional engagementtherebetween. The teeth arrangement provides a ratcheting or ladder-likemechanism to enable expansion while eliminating or minimizing canting,tilting, or settling of the spacer 200.

The teeth 226 and 228 of the expandable spacer 200 may be elasticallydeformable in one direction so that when the spacer 200 is expanded, theteeth 226 of the base component 202 may give as the teeth 228 of the topcomponent 204 are pushed past them. Once a set of teeth 228 engages theteeth 226 of a tier above, there is resistance to a return of that setof teeth 228 to a lower tier of the set of base component teeth 226.Further, the spacing between tiers of teeth 226/228 may be establishedin specific increments so that the surgeon is able to adjust the heightincrease of the spacer 200 very specifically by counting the number oftiers of engagement of the teeth that occurs. For example, each tier maybe spaced from adjacent tiers by one millimeter. Making threeincremental changes in stepped tier engagements would correspond to athree millimeter spacer expansion.

Relatedly, the height adjuster 206 may be arranged with coding such thatits rotation by some selected value corresponds to a tier change. I.e.,a quarter-turn culminating with a click can be used to signify that atier change has been made. Those of skill in the art will recognize thatother arrangements for linking height adjuster changes with expansionvalues may be established without deviating from this concept.

The configuration of the expandable spacer 200 shown in FIGS. 18-23 hasno cant-minimizing silos and towers arrangement such as included in thespacer 10 of FIGS. 4-11. Nevertheless, the spacer 200 may optionallyinclude such silo-and-tower arrangement. If the silos and towers areincluded, they may or may not also include teeth corresponding to theteeth 226/228 of the perimeter walls of the base component 202 and thetop component 204.

Although not depicted in this embodiment, the spacer 200 can be madewith steering ports or interface sites to enable a surgeon to positionthe spacer in a desired position. The expandable spacer 200 of thepresent invention may include on-axis and/or off-axis insertionarrangements or ports as shown in FIGS. 16 and 17 in relation to spacer10. Further, the spacer 200 may be rectangular, curved or otherconfigurations of interest. The spacer may be placed in position using aplacement device or tool as described in the other two provisionalapplications listed herein.

The present invention also encompasses a method of inserting andpositioning the expandable spacers described above into theintervertebral disc space between two adjacent vertebrae comprising thesteps of providing an expandable spacer including a top component, abase component in engagement with the top component, and an expansionmechanism arranged to change the top component's position with respectto the base component. The spacer may include one or more off-axispositioning interface sites and/or one or more on-axis positioningsites, the on-axis interface being coincident with or parallel to thelongitudinal axis of the spacer, and the off-axis interface being angledwith respect to the longitudinal axis. The method may comprise the stepsof engaging a tool to the on-axis interface if present, inserting thespacer at least partially into the intervertebral disc space by movingthe tool substantially along an insertion direction, engaging the toolto the off-axis interface if present, and inserting the spacer furtherinto the intervertebral disc space by moving the tool substantiallyalong the insertion direction, such that the longitudinal axis of thespacer is angled with respect to the insertion direction. The method mayfurther include the steps of engaging the tool to a second off-axisinterface of the spacer if present, and inserting the spacer furtherinto the intervertebral disc space by moving the tool substantiallyalong the insertion direction. The spacer may further include a frontend having frictional properties that are greater than frictionalproperties of a rear end of the spacer, and the inserting steps mayinclude allowing the front end to turn within the intervertebral discspace as it frictionally engages one or both of the adjacent vertebrae.The method may further include the step of packing bone graftingmaterial into at least one of the on-axis interface, the off-axisinterface, and an opening in the spacer. The method further includes thestep of expanding the spacer. The method further includes the optionalstep of packing bone grafting material into one or more ports of thespacer after expansion has occurred.

The expandable spacers 10, 100, and 200 of the present invention havebeen described with respect to three specific embodiments and methods ofusing the same. Nevertheless, it is to be understood that variousmodifications may be made without departing from the spirit and scope ofthe invention. All equivalents are deemed to fall within the scope ofthese descriptions of the invention.

The invention claimed is:
 1. A method of implanting a spinal spacer intoan intervertebral space of a patient, comprising: engaging a tip of aninsertion tool to a threaded on-axis interface of the spacersubstantially parallel to a longitudinal axis of the spacer; inserting afront end of the spacer into the intervertebral space along an insertiondirection substantially parallel to the longitudinal axis of the spacer;continuing to insert the spacer so that the front end of the spacerturns until the longitudinal axis of the spacer is non-parallel to theinsertion direction; further inserting the spacer into theintervertebral space while the insertion tool is non-parallel to thelongitudinal axis of the spacer; and actuating an expansion mechanism toexpand the spacer by increasing a distance between a top surface of thespacer and a bottom surface of the spacer, the expansion mechanism beingangled with respect to the longitudinal axis of the spacer; wherein theinsertion tool includes a shaft configured for positioning outside theintervertebral space while the spacer is within the intervertebralspace, the shaft of the insertion tool being non-pivotable with respectto the tip of the insertion tool, the tip configured to be threadedlycoupled to the spacer during the step of actuating the expansionmechanism.
 2. The method of claim 1, further comprising disengaging theinsertion tool from the spacer.
 3. The method of claim 2, furthercomprising removing the insertion tool from the intervertebral space. 4.The method of claim 1, further comprising at least partially filling anopening in the spacer with bone grafting material.
 5. The method ofclaim 4, wherein the step of at least partially filling an opening inthe spacer with bone grafting material includes inserting the bonegrafting material into a graft window in the spacer after the step ofactuating the expansion mechanism to expand the spacer.
 6. The method ofclaim 1, wherein the step of actuating the expansion mechanism furthercomprises driving a screw to increase the distance between the top andbottom surfaces of the spacer.
 7. The method of claim 1, wherein thestep of actuating the expansion mechanism further comprises driving awedge to increase the distance between the top and bottom surfaces ofthe spacer.
 8. The method of claim 1, wherein the step of actuating theexpansion mechanism further comprises driving a cam to increase thedistance between the top and bottom surfaces of the spacer.
 9. Themethod of claim 1, further comprising disengaging the insertion toolfrom the on-axis interface prior to the step of further inserting thespacer into the intervertebral space.
 10. The method of claim 9, furthercomprising engaging the insertion tool to an off-axis interface afterthe step of inserting a front end of the spacer into the intervertebralspace and before the step of further inserting the spacer into theintervertebral space.
 11. The method of claim 10, further comprisingpacking bone grafting material into the spacer through the on-axisinterface after the step of actuating the expansion mechanism to expandthe spacer.
 12. The method of claim 10, further comprising packing bonegrafting material into the spacer through the off-axis interface afterthe step of actuating the expansion mechanism to expand the spacer. 13.The method of claim 1, wherein the step of actuating the expansionmechanism to expand the spacer is performed such that the top surface ofthe spacer does not tilt with respect to the bottom surface of thespacer.
 14. The method of claim 13, wherein the step of actuating theexpansion mechanism to expand the spacer includes driving a topcomponent of the spacer away from a base component of the spacer, thetop component of the spacer remaining in contact with the base componentduring the actuating step.
 15. The method of claim 14, wherein the stepof actuating the expansion mechanism to expand the spacer includessliding at least one silo in the top component along at least one towerin the base component.
 16. The method of claim 14, wherein the step ofactuating the expansion mechanism to expand the spacer includes slidingat least one tower in the top component along at least one silo in thebase component.
 17. The method of claim 1, wherein the inserting stepsare performed so that, after insertion of the spacer is completed, thelongitudinal axis of the spacer is rotated approximately 90 degrees withrespect to the insertion direction.
 18. A method of implanting anexpandable spinal spacer into an intervertebral space of a patient,comprising: providing the expandable spacer including a top component, abase component, and an expansion mechanism arranged to change a positionof the top component respect to a position of the base component;providing a tool including a shaft and a tip; engaging the tip of thetool to a threaded tool interface of the spacer substantially parallelto a longitudinal axis of the spacer; inserting the spacer at leastpartially into the intervertebral space by moving the tool substantiallyalong an insertion direction, the insertion direction beingsubstantially parallel to the longitudinal axis of the spacer; turning afront end of the spacer as the spacer is being inserted at leastpartially into the intervertebral space; and inserting the spacerfurther into the interverterbral space by moving the tool substantiallyalong the insertion direction, such that the longitudinal axis of thespace is angled with respect to the insertion direction; wherein theshaft of the tool is configured for positioning outside theintervertebral space while the spacer is within the intervertebral spaceand the tip is coupled to the spacer, the shaft of the tool beingnon-pivotable with respect to the tip of the tool, the tip configured tobe threadedly coupled to the spacer while the top component of thespacer is moved away from the base component of the spacer.
 19. Themethod of claim 18, further comprising actuating the expansion mechanismto a distance between the top component of the spacer and the basecomponent of the spacer, the expansion mechanism being angled withrespect to the longitudinal axis of the spacer.
 20. The method of claim19, wherein the expansion mechanism is substantially parallel to theinsertion direction during the step of actuating the expansionmechanism.